MedScrub connects to Practice Fusion using SMART on FHIR Client Credentials with asymmetric JWT authentication — the same auth pattern used for Epic Backend Services. Patient records are pulled directly from the Practice Fusion FHIR R4 API, including system-level bulk $export for population workflows. PHI passes through the self-hosted de-identification proxy before reaching any large language model.
Integration model
MedScrub pulls patient data directly from the Practice Fusion FHIR R4 endpoint using OAuth 2.0 Client Credentials with a signed asymmetric JWT. The integration supports both individual patient reads and system-level bulk $export for population-health workflows. Patient data flows into the MedScrub clinical data repository for longitudinal context. Proxy-side client code is planned — auth pattern already exists in the codebase.
Capabilities
MedScrub pulls the patient record from the EHR before the appointment and surfaces care gaps, screening recommendations, and overdue chronic-disease milestones for the loaded patient.
Drafts a structured SOAP note from the patient chart, with ICD-10 coding and E/M level analysis. After physician review and sign-off, the note writes back to the EHR as a FHIR DocumentReference.
Runs HEDIS / USPSTF / MIPS quality-measure gap analysis across patient panels — breast, cervical, colorectal, diabetes, blood pressure, and depression screening.
Batch pre-visit intelligence for the full clinic day, run overnight against the CDR, with delivery to mobile.
Automates payer chart-request response by searching the longitudinal record for measure-specific evidence.
Drafts prior-auth requests and denial appeals grounded in the patient chart, including evidence pulled from prior diagnostic reports and procedures.
Monthly chronic care management documentation for CPT 99490 / 99491 billing, generated from the longitudinal record.
2021-AMA MDM framework analysis flags under-coding opportunities with revenue-at-risk surfaced in the UI.
Data scope
Setup
01
Register MedScrub at the Practice Fusion developer portal (practicefusion.com/fhir/api-specifications). Obtain client credentials for the sandbox and production environments.
02
Add EHR_PRACTICE_FUSION_* environment variables to the proxy .env (client ID, private key, FHIR base URL). The proxy reads these at startup.
03
Verify patient reads and bulk $export against the Practice Fusion sandbox before switching to production credentials. All scoped resources should return FHIR R4 bundles.
Tier limitations
The embedded sidebar integration is the EHR vendor’s third-party app pattern. Some MedScrub workflows require deeper FHIR connectivity that this tier does not provide.